Understanding Addiction

Introduction to Addiction

Drug addiction is a complex illness. It is characterized by compulsive, at times uncontrollable drug craving, seeking, and use that persist even in the face of extremely negative consequences. For many people, drug addiction becomes chronic, with relapses with possible even after long periods of abstinence.

Most people probably continue to think of addiction--particularly illicit drugs--as primarily a moral or character problem, something cause by lack of willpower or degeneracy. Scientists have begun to understand why addicted people may sacrifice everything that's important to them --their jobs, their families, thier homes -- for a chemical fix.

The path to drug addiction begins with the act of taking drugs. Over time a person's ability to choose not to take drugs can be compromised. Drug seeking becomes compulsive, in large part as a result of the effects of prolonged drug use on brain functioning and, thus on behavior.

The compulsion to use drugs can take over the individual's life. Addiction often involves not only compulsive drug taking but also a wide range of dysfunctional behaviors that can interfere with normal functioning in the family, the workplace and the broader community.

Addiction can place people at increased risk for a wide variety of other illnesses. These illnesses can be brought on by behaviors, such as poor living and health habits, that often accompany life as an addict, or because of the toxic effects of the drugs themselves.

Because addiction has so many dimensions and disrupts so many aspectsof an individual 's life treatment for this illness is never simple. Drug treatment must help the individual to stop using drugs and maintain a drug-free lifestyle, while achieving productive functioning in the family, at work, and in society. Effective drug abuse and addiction treatment programs typically incorporate many components, each directed to a particular aspect of the ilness and its consequences.

Three decades of scientific research and clinical practice has yielded a variety of effective approaches to drug addiction treatment. Extensive data document that drug addiction treatment is as effective as are treatments for most othersimilarly chronic medical conditions. In spite of scientific evidence that establishes the effectiveness of drug abuse treatment, many people believe treatment is ineffective. In part, this is because of unrealistic expectations.

Many people equate addiction with simply using drugs and therefore expect addiction should be cured quickly, and if it is not, treatment is a failure. In reality, because addiction is a chronic disorder, the ultimate goal of long-term abstinence often requires sustained and repeated treatment episodes.

The so-called disease model doesn't mean that addicts cannot stop using drugs-only that doing so is difficult and often requires treatment and major lifesytle changes. Addiction is a disease that causes changes in the brain which then drive certain behavior-taking the drug compulsively-but addicts can learn to change the behavior. Treatment and recovery from addiction are possible.

Opioid addiction is a neurobehavioral syndrome characterizedby the repeated, compulsive seeking or use of an opioid despite adverse social, psychological, and/or physical consequences.

Addiction is often (but not always) accompanied by physical dependence, a withdrawal syndrome, and tolerance.Physical dependenceis defined as a physiological state of adaptation to a substance, the absence of which produces symptoms andsigns of withdrawal.Withdrawal syndromeconsists of a predictable group of signs and symptoms resulting from abrupt removal of, or a rapid decrease in the regular dosage of, a psychoactive substance.

The syndrome is often characterized by overactivity of the physiological functions that were suppressed by the drug and/or depression of the functions that were stimulated by the drug. Toleranceis a state in which a drug produces a diminishing biological or behavioral response; in other words, higher doses are needed to produce the same effect that the user experienced initially.

It is possible to be physically dependent on a drug without being addicted to it, and conversely, it is possible to be addicted without being physicallydependent (Nelson et al. 1982).

An example of physical dependence on opioids without addictionis a patient with cancer who becomes tolerant of and physically dependent on opioids prescribed to control pain. Such a patient may experience withdrawal symptoms with discontinuation of the usual dose but will not experience social, psychological, or physical harm from using the drug and would not seek out the drug if it were no longer needed for analgesia (Jacox et al. 1994).

An example of addiction to opioids without physical dependenceis a patient addicted to oxycodone who has been recently detoxified from the drug. In this situation, the patient may no longer be suffering from withdrawal symptoms or tolerance but may continue to crave an opioid high and will invariably relapse to active opioid abuse without further treatment.

Factors contributing to the development of opioid addictioninclude the reinforcing properties and availability of opioids, family and peer influences, sociocultural environment, personality, and existing psychiatric disorders.

Genetic heritage appears to influence susceptibilityto alcohol addiction and, possibly, addiction to tobacco and other drugs as well (Goldstein 1994).

Current State Of Opioid Addiction Treatment

There are two main modalities for the treatment of opioid addiction: pharmacotherapy and psychosocial therapy. Pharmacotherapies now available for opioid addiction include (1) agonist maintenance with methadone; (2) partial-agonist maintenance with buprenorphine or buprenorphine plus naloxone; (3) antagonist maintenance using naltrexone; and (4) the use of antiwithdrawal ("detoxification") agents (e.g., methadone, buprenorphine, and/or clonidine) for brief periods, and in tapering doses, to facilitate entry into drug -free or antagonist treatment.

Psychosocial approaches (e.g., residential therapeutic communities), mutual -help programs (e.g., Narcotics Anonymous), and 12 -Step - or abstinence-based treatment programs are important modalities in the treatment of addiction to heroin and other opioids, either as stand-alone interventions or in combination with pharmacotherapy.

In 2003, more than 200,000 individuals in the United States were maintained on methadone or LAAM (SAMHSA 2002a ). Although precise data are difficult to obtain, it is estimated that fewer than 5,000 individuals are maintained on naltrexone for opioid addiction.

The number of individuals in 12 -Step programs is unknown because of the undisclosed nature of the programs and their assurance of anonymity.

The number of patients in residential therapeutic community treatment who identify opioids as their primary drugs of abuse is conservatively estimated at 3,000-4,000. (This estimate is derived from various sources, both published, such as Drug Abuse Treatment Outcome Studies [DATOS], and unpublished, such as Therapeutic Communities of America reports found at:

"Sometimes, the best way to begin correctinga problem is to step back and examine why that problem exists in the first place. Whether the person struggling with opioid dependence is you or someone you care about, understanding this disease --what causes it, what contributes to it,and why it persists --is a key to being part of the solution."

We have provided the information here to help explain and make some sense of opioid dependence, so that you feel better equipped to undertake, or help someone else undertake, the necessary steps toward treatment and recovery. It is our hope that you will take the time to read all of it. It will beome a helpful tool in your recovery, for knowledge is power.